| Regimental number | 3/2200 |
| Occupation | Baker's assistant |
| Next of kin | Mother, Mrs J P Keen, Regent Street, Hawera |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 13th Reinforcements, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Sources | Nominal Roll Vol. 2: Roll 33, p. 24 |